CLG Vital Data

Measuring Pediatric Axillary Temperature
STEP/TASK Cases
Getting Ready: WIPE +
1. Prepare equipment (thermometer tray, tissue paper and thermometer)
Procedure:
1. Place the baby on her/his back or side on a clean, warm surface.
2. Shake the thermometer until it is below 35°C.
3. Place the tip of the thermometer high in the apex of the axilla with thermometer
parallel to long axis of the body and hold the arm continuously against the body for
at least two minutes.
4. Remove the thermometer and read the temperature by holding it at eye-level
and rotating the stem until the mercury is clearly seen
Post Procedure:
1. Wipe the thermometer with a disinfectant solution after each use.
2. Record results on a notepad
Measuring Radial Pulse

STEP/TASK Cases
Getting Ready: WIPE +
1. Prepare equipment: Watch or clock with a counter for seconds.
2. Assist the patient to pronate and slightly fix the forearm.
Procedure:
1. Locate the radial artery just medial to the distal radius and proximal to the patient’s
wrist on the thumb side.
2. Place the tips of the index, middle & ring fingers just proximal to the patient’s wrist
on the thumb side, orienting them over the vessel.
3. Push lightly at first, gradually adding pressure till you feel the pulse.
4. Repeat procedure with other arm for assessment of equality
5. Search for a water hammer pulse (collapsing pulse) by feeling along the radial side
of forearm while elevating the arm above the level of the heart
Post Procedure:
1. Wash the hands.
2. Record the results as beats / minute and comment on regularity and volume.
During palpation, note and comment on the following:
1
1. Rate:
Measure the rate of the pulse (recorded in beats per minute). Count for 30 seconds and multiply by 2.
If the rate is particularly slow or fast or irregular, it is probably best to measure for a full 60 seconds in
order to minimize the impact of any error in recording over shorter periods of time.
2. Rhythm:
Is the time between beats constant? so it may be : (1- Regular. 2- Regular irregularity (if there are
extra beats). 3- Irregular irregularity (if there is no discernable pattern as cases of atrial fibrillation).
if the pulse is irregular; verify the rate by listening over the heart (apical pulse).
3. Volume: (i.e. the subjective sense of fullness).
• Normal.
• Big.
• Small
4. State of the vessel wall:
• Place the tip of the three fingers ( ring , middle , index ) over the radial artery
• Press proximally using the index finger to close the radial artery.
• Press by the ring finger distally to prevent the back flow.
• Palpate the vessel wall by the middle finger.
5. Special character:
Comment if there is a special character as Water hammer pulse.
6. Compare to the other radial pulse.
Measuring Apical rate

STEP/TASK Cases
Getting Ready: WIPE
2. Assist the patient to a comfortable position: supine or semi-sitting position.
3. Expose chest well.
Procedure:
1. By inspection: look tangentially, from the side of the patient for apical pulsation.
2. Palpate the apex by palmer surface of the hand.
3. Localize the apex (the lowermost outermost visible palpable powerful pulsation)
with the tip of your index finger.
4. Auscultate the apex with the bell of the stethoscope.
Post Procedure:
1. Wash your hands.
2. Record the results as beats / minute
2
Assessment of Peripheral pulses
STEP/TASK Cases
Getting Ready
1. Greet the patient respectfully and with kindness.
2. Tell the patient you are going to examine the different pulses
3. Position the patient as suitable for each pulse.
4. Wash hands thoroughly and dry them
5. Put on new examination or high-level disinfected surgical gloves on both hands.
6. Exposure: Ask the patient to remove all clothing covering the examination areas
Assessment of Peripheral Arterial pulses:
1. Femoral artery:
1. Lay the patient supine
2. Partially flex the knee
3. Abduct and externally rotate the hip
4. Using the tips of your fingers
5. Feel the pulse below the mid-inguinal point
6. Compare both sides.
2. Popliteal artery:
1. The patient to lie supine and partially flex the knees
2. Feel the pulse with the fingers encircling and supporting the knee on both
sides.
3. Alternate method:
▪ Ask the patient to lie prone
▪ Using the tips of your fingers pressing against the femur
▪ Feel along the line of the artery
▪ Compare both sides.
3. Posterior tibial artery:
1. The patient to lie supine
3. Feel the pulse in the groove between the medial malleolus and tendo-achilles.
4. Dorsalis pedis artery:
2. Feel the pulse lateral to the extensor hallucis longus tendon and proximal to the
first metatarsal space.
3
5. Brachial artery:
1. Partially flex the elbow
2. Using the thumb
3. Feel the pulse over the elbow just medial to the biceps tendon.
Measuring the Respiratory Rate

STEP/TASK Cases
Getting Ready: WIPE
2. Assist the patient to a comfortable semi-sitting position
3. Do not explain the procedure to the patient,
Procedure:
1. Pretend you are measuring the radial pulse, while inspecting and counting the
elevations of the chest wall in 30 seconds.
2. If you could not count the respiratory rate easily because of clothes or any other
reason, let the patient lie flat and pretend that you are measuring the apical pulse or
performing cardiac examination while counting the respiratory rate in 30 seconds.
Post Procedure:
1. Wash your hands.
2. Record the results as breathes/ minute and comment on regularity and difficulty.
Measuring Blood Pressure

STEP/TASK Cases
Getting ready: WIPE
1. Put the patient in a supine or sitting position with back supported for 5 minutes and
legs uncrossed, feet flat on the floor and patient relaxed.
2. Prepare equipment (stethoscope and sphygmomanometer)
3. If the pulses are equal, use right arm.
4. If unequal, use arm with the strongest pulse.
5. Take off the sleeve of the identified arm.
6. Arm should be abducted, supinated & at the level of the heart (if sitting, use arm
support).
7. Choose the correct size of the width of the cuff. The bladder at least 40% of the
circumference of the midpoint of the upper arm and the length 80% of the upper
arm.
4
STEP/TASK Cases
Procedure
1. Place the cuff around the upper arm with the lower edge of the cuff, with its
tubing connections one inch above the antecubital space across the inner side of
the elbow.
2. Wrap the cuff snuggly around the inflatable inner bladder centered over the area
of the brachial artery.
3. Close the valve of the pump.
4. Inflate the cuff while palpating the radial pulse. Inflate the cuff rapidly to 70
mmHg then 10 mmHg at time till the pulse will no longer be felt (the pulse
obliteration pressure). This is the approximate systolic blood pressure.
5. Deflate the cuff
6. Mentally add 20-30 mm Hg to previously measured number to know the
maximum inflation level (MIL).
7. Place the earpieces of the stethoscope into ears, with the earpiece angles turned
forward toward the nose.
8. Palpate the brachial artery.
9. Apply the diaphragm of the stethoscope over the brachial artery, just below but
not touching the cuff or tubing.
10. Close the valve of the pump.
11. Inflate the cuff rapidly to the MIL previously determined.
12. Open the valve slightly and maintain a constant rate of deflation at approximately
2mm per second.
13. Allow the cuff to deflate
14. Listen throughout the entire range of deflation until 10mm Hg below the level of
the diastolic reading. The first loud beat will be the systolic recording (Korotkopf
I), the disappearance of sound (Korotkopf V) will denote the diastolic reading*.
15. Fully deflate the cuff by opening the valve.
16. Remove the stethoscope earpieces from the ears.
17. Write down the systolic and diastolic readings to the nearest 2mmHg.
* In case the sound continues to zero, record the diastolic blood pressure as a range
of the kortokopf IV sound to zero ? change in character/muffling.

CLG Vital Data

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Measuring Pediatric Axillary Temperature

Measuring Radial Pulse

Measuring Apical rate

Measuring the Respiratory Rate

Measuring Blood Pressure

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